Cluster landscape shows 52 commissioners

Primary care trusts are clustering into 52 commissioners across England – ranging from a £4.7bn giant to an £800m standalone PCT.

UPDATED 28 April

Analysis of the groups, which have been confirmed by strategic health authorities, shows apparently different approaches between regions (see table, below).

The largest cluster is Greater Manchester, which includes 10 PCTs covering a population of 2.6 million, with a combined budget of £4.7bn for 2011-12.

The smallest is Somerset, which remains a standalone PCT with a 530,000 population and £797m budget. A PCT spokesman said there were several reasons for remaining standalone, including its relatively low management costs and its coterminosity with a local authority and an emerging federated GP consortium. It has performed well for several years, the spokesman said.

There are eight standalone PCTs in total. Of these, Surrey, Cumbria, and North Yorkshire and York all have known finance problems, which may have been a disincentive for others to cluster with them.

The South West, North East, East of England, East Midlands and Yorkshire all have smaller clusters, by population and budget, compared with the other regions. In the North East this reflects the fact that the region already has the smallest PCTs.

Two PCTs have crossed SHA boundary lines. NHS Bassetlaw, previously under East Midlands SHA, is joining the south Yorkshire cluster, under Rotherham chief executive Andy Buck.

Most cluster chief executive appointments are from their constituent PCTs but there are a few exceptions.

Denise McLellan, who was previously NHS Walsall chief but has been on secondment to the Department of Health, has been appointed as Birmingham’s chief executive, and Caroline Taylor, previously of NHS Croydon in south west London, is now north central London’s chief executive.

PCT Network director David Stout said some larger clusters, such as Greater Manchester and Merseyside, were formed in urban areas which would be difficult to split in a logical way.

He said groups were also shaped by patient flows. In addition, smaller clusters may be retained where local authorities that were coterminous with their PCTs had a “history of war” with neighbouring councils and would resist sharing a cluster.

Mr Stout also said it would be hard for clusters to transfer and share funds between member PCTs if one had a financial shortfall. PCTs remained accountable for their finances, meaning their remaining directors, and commissioning consortia within them, would want to ensure they kept their funds.